Severe hypercalcemia complicated by acute pancreatitis revealing generalized bone lysis metastasis: Case report and review

Malignant hypercalcemia is a frequent metabolic complication of osteophilic tumors, exceptionally revealing cavitary cancer, but its prognosis remains poor despite early and adequate management. We report the case of a young patient, smoker without any previous history, admitted for the management of a digestive symptoms made of abdominal pain with food vomiting. The patient had an electrocardiogram withchest computed tomography scan and BBC evoking PA on malignant hypercalcemia. An etiological investigation was conducted to confirm the tumoral origin of the hypercalcemia. We put the patient on hyperhydration with corticotherapie and biohosphonates with a good clinical and biological improvement. Malignant hypercalcemia affects about 10%-20% of patients with cancer including nasopharyngeal carcinoma. Its clinical presentation varies according to the extent and speed of onset, responsible for multivisceral involvement including kidney, heart, neuropsychiatric system, which may engage the patient's vital prognosis. The therapeutic management is based on 4 main principles; hyperhydration, increase of urinary calcium excretion by loop diuretics, decrease of bone resorption by biphosphonates and extrarenal purification which remains the ideal choice in case of life-threatening severe hypercalcemia. Acute hypercalcemic pancreatitis as a mode of revelation of cavum cancer has almost never been described in the literature

Capillary hyperpermeability syndrome: A fatal complication of acute leukaemia: Case report and review

Introduction

The capillary hyperpermeability syndrome is a rare disease that should be suspected in the presence of recurrent generalized edema without obvious cause, which may be idiopathic or secondary.

Case presentation

In this case, we report a Clarkson syndrome secondary to an acute leukemia affecting a 4-year-old child admitted to the emergency room in respiratory and hemodynamic distress with a generalized oedematous syndrome and a bone marrow failure syndrome. Laboratory tests concluded that the patient was suffering from an acute lymphoblastic leukemia, hypoalbuminemia, pericardial effusion, and the absence of any other cause that is in favor of a capillary leak syndrome.In spite of the filling and the introduction of drugs, the cardio respiratory arrest could not be recovered and the child died 24h after his admission.

Discussion

It is a rare pathology described for the first time in 1960, generally secondary to a pathological state and more rarely idiopathic, to be evoked in front of clinical and biological parameters which are hypoalbuminemia, hemiconcentration and hypoperfusion, after having eliminated a sepsis in the first place.The treatment is based on the management of the acute phase by filling with crystalloids, drugs or even steroids, and as a preventive treatment of relapses immunoglobulins or theophylline are used.

Conclusion

The evolution can be quickly fatal, that's why it is necessary to know how to evoke this syndrome in front of a similar clinical presentation.

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Capillary hyperpermeability syndrome is a rare cause of generalized edema.

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The diagnosis is made on the basis of hypoalbuminemia, hemoconcentration, and hypoperfusion.

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A monoclonal gammopathy type igG is rarely found in children unlike in adults.

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Relapse prevention remains a very important part of treatment with immunoglobulin, theophylline or anti TNF alpha.

Purpura as a late complication of covid-19 infection that should not be ignored: Case report and brief review

Introduction and importance

The SARS COV2 infection is a challenging pandemic that has affected millions of people with a very high mortality rate. In addition to the typical respiratory symptoms, it can also cause variable skin lesions, such as vascular purpura in some exceptional cases.

Case presentation

We report the case of a 60-year-old woman who was admitted for a SARS COV2 infection, the evolution was marked by the appearance of a vascular purpura at D20 after the beginning of the symptoms.

Discussion

The cutaneous manifestations associated with the SARS COV2 infection are polymorphic. Vascular purpura is one of them. Its diagnosis is retained in the light of a combination of arguments, which makes it a real challenge for the physician to diagnose it. The management of the disease is based on a symptomatic treatment. The clinical evolution is, in general, favorable.

Conclusion

Although rare and still not fully explained, skin involvement during SARS COV2 infection has been described. It should not be neglected and it should be diagnosed early and treated appropriately, especially in asymptomatic patients.

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Infection with the COVID-19 virus can be manifested by clinical signs of varying severity, sometimes fatal.

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Being a systemic disease, SARS COV2 infection may be revealed, in addition to respiratory symptoms, by skin lesions including vascular purpura

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We report a case of vascular purpura occurring post-infection

[Whitnall's ligament suspension technique in ptosis surgery]

INTRODUCTION

We report our experience in ptosis surgery using the technique of Whitnall's ligament suspension in congenital ptosis.

MATERIALS AND METHODS

A retrospective study of 20 cases of congenital ptosis treated by the technique of Whitnall's ligament suspension, 8 by the posterior approach and 12 by the anterior approach. Patients were randomized into 3 groups according to upper eyelid levator function. Postoperative follow-up was obtained on day 1, one week, one month, three months and one year.

RESULTS

All patients had good correction; 3 had an under-correction as a three-month final result, of which only one required reoperation for an unsatisfactory result. There was no abnormal curvature of the lid margin or malposition of the lid crease. All lids required initial over-correction, which yielded a good end result. The success rate was 85%.

DISCUSSION

The technique of Whitnall's ligament suspension for the treatment of ptosis has rarely been described in the literature, but the few studies reported show its equivalence in terms of results to other surgical techniques for treatment of ptosis and also confirm its superiority in terms of respect for anatomy and physiology of the eyelid.

CONCLUSION

This technique is particularly suited to the treatment of congenital ptosis with moderate levator function, and the results are promising.